MONTPELIER, Vt. - Accustomed to being the first to dip its toe into hot-button issues, Vermont is preparing to provide public health care to all residents regardless of income, moving toward a government-run system that will take it as close to Canada philosophically as it is geographically.
Gov. Peter Shumlin is expected to sign legislation this month marking the first step on the path to phasing out most private insurance. The effort puts Vermont well in front of last year's federal health care overhaul.
The ultimate goal, Shumlin said recently, is a Canadian-style system "where health care is a right and not a privilege."
But it's not clear yet how Vermont - the first state to ban slavery in its constitution and to give marriage-like rights to same-sex couples - will achieve universal health care. The legislation places responsibility for the details with a powerful new state board.
The Vermont bill sets up a five-member board which, in consultation with the executive branch and Legislature, is to answer the big unanswered questions in this year's bill. Those include how the system will be paid for - some have suggested a payroll tax on employers and workers; what benefits will be covered; what co-pays and deductibles it would include; and other details.
Despite the growing opposition to the federal law, Vermont, where liberal Democrats control the governor's office and both houses of the Legislature, is undaunted in moving in the direction of Canada, which pays for its health care system through taxes.
And supporters say the state has built-in advantages. Vermont, with a small population of about 620,000, is often ranked as one of the healthiest states. It is well below the national average for infant mortality, childhood obesity, AIDS diagnoses and a range of other indicators of poor health, according to figures kept by the Kaiser Family Foundation.
The Census Bureau reported that, in 2007, Vermont ranked sixth in the country in physicians per capita, with 374 per 100,000, versus a national average of 271 per 100,000. And about 90 percent of Vermonters have some form of health insurance already.